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Rosenthal VD, Yin R, Brown EC, Lee BH, Rodrigues C, Myatra SN, Kharbanda M, Rajhans P, Mehta Y, Todi SK, Basu S, Sahu S, Mishra SB, Chawla R, Nair PK, Arjun R, Singla D, Sandhu K, Palaniswamy V, Bhakta A, Nor MBM, Chian-Wern T, Bat-Erdene I, Acharya SP, Ikram A, Tumu N, Tao L, Alvarez GA, Valderrama-Beltran SL, Jiménez-Alvarez LF, Henao-Rodas CM, Gomez K, Aguilar-Moreno LA, Cano-Medina YA, Zuniga-Chavarria MA, Aguirre-Avalos G, Sassoe-Gonzalez A, Aleman-Bocanegra MC, Hernandez-Chena BE, Villegas-Mota MI, Aguilar-de-Moros D, Castañeda-Sabogal A, Medeiros EA, Dueñas L, Carreazo NY, Salgado E, Abdulaziz-Alkhawaja S, Agha HM, El-Kholy AA, Daboor MA, Guclu E, Dursun O, Koksal I, Havan M, Ozturk-Deniz SS, Yildizdas D, Okulu E, Omar AA, Memish ZA, Janc J, Hlinkova S, Duszynska W, Horhat-Florin G, Raka L, Petrov MM, Jin Z. Incidence and risk factors for catheter-associated urinary tract infection in 623 intensive care units throughout 37 Asian, African, Eastern European, Latin American, and Middle Eastern nations: A multinational prospective research of INICC. Infect Control Hosp Epidemiol 2024; 45:567-575. [PMID: 38173347 DOI: 10.1017/ice.2023.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To identify urinary catheter (UC)-associated urinary tract infection (CAUTI) incidence and risk factors. DESIGN A prospective cohort study. SETTING The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries. PARTICIPANTS The study included 169,036 patients, hospitalized for 1,166,593 patient days. METHODS Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression. RESULTS Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower-middle-income countries (3.05); and with patients in public hospitals (5.89).The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P < .0001), female sex (aOR, 1.39; P < .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P < .0001), UC DU ratio (aOR, 1.09; P < .0001), public facilities (aOR, 2.24; P < .0001), and neurologic ICUs (aOR, 11.49; P < .0001). CONCLUSIONS CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
- International Nosocomial Infection Control Consortium, INICC Foundation, Miami, Florida, United States
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Eric Christopher Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | | | - Camilla Rodrigues
- Department of Microbiology, Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Sheila Nainan Myatra
- Department of Anesthesiology, Critical Care and Pain, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
| | | | - Prasad Rajhans
- Deenanath Mangeshkar Hospital and Research Center Erandwane Pune, Pune, India
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta the Medicity, Haryana, India
| | - Subhash Kumar Todi
- Department of Critical Care, Advanced Medicare Research Institute Hospitals, Kolkata, India
| | - Sushmita Basu
- Advanced Medicare Research Institute Mukundapur Unit, Kolkata, India
| | | | | | - Rajesh Chawla
- Department of Critical Care, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Rajalakshmi Arjun
- Department of Critical Care, Kerala Institute of Medical Sciences Health, Trivandrum, India
| | | | - Kavita Sandhu
- Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | | | - Arpita Bhakta
- Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd-Basri Mat Nor
- Department of Anesthesia and Critical Care, International Islamic University Malaysia, Kuantan Pahang, Malaysia
| | - Tai Chian-Wern
- Department of Critical Care, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | | | | | - Aamer Ikram
- Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - Nellie Tumu
- Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Lili Tao
- Department of Pneumonology, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | | | | | | | | | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
| | | | | | | | | | | | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Oguz Dursun
- Akdeniz University Medical School, Antalya, Turkey
| | - Iftihar Koksal
- Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Merve Havan
- Ankara University Faculty of Medicine, Ankara, Turkey
| | | | | | - Emel Okulu
- Ankara University Faculty of Medicine Childrens Hospital NICU, Ankara, Turkey
| | - Abeer Aly Omar
- Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
| | - Ziad A Memish
- King Saud Medical City, Ministry of Health, Riyadh, the Kingdom of Saudi Arabia
| | - Jarosław Janc
- 4th Clinical Military Hospital, Wroclaw, Poland, Europe
| | - Sona Hlinkova
- Faculty of Health, Catholic University in Ruzomberok, Central Military Hospital Ruzomberok, Ruzomberok, Slovakia
| | - Wieslawa Duszynska
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - George Horhat-Florin
- University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
| | - Lul Raka
- National Institute For Public Health, Prishtina, Kosovo
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Bulgaria
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
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Rosenthal VD, Yin R, Jin Z, Alkhawaja SA, Zuñiga-Chavarria MA, Salgado E, El-Kholy A, Zuniga Moya JC, Patil P, Nadimpalli G, Pattabhiramarao RN, Zala D, Villegas-Mota I, Ider BE, Tumu N, Duszynska W, Nguyet LTT, Nair PK, Memish ZA. International Nosocomial Infection Control Consortium (INICC) report of health care-associated infections, data summary of 25 countries for 2014 to 2023, Surgical Site Infections Module. Am J Infect Control 2024:S0196-6553(24)00167-6. [PMID: 38604442 DOI: 10.1016/j.ajic.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Surgical site infection (SSI) rates are higher in low-resource countries (LRC) than in high-income counterparts. METHODS Prospective cohort study using the INICC Surveillance Online System, from 116 hospitals in 75 cities across 25 Latin-American, Asian, Eastern-European, and Middle-Eastern countries: Argentina, Bahrain, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Egypt, Honduras, India, Kosovo, Kuwait, Lebanon, Mexico, Mongolia, Pakistan, Papua New Guinea, Philippines, Poland, Romania, Saudi Arabia, Thailand, Turkey, Venezuela, Vietnam. CDC/NHSN definitions were applied. Surgical procedures (SPs) were categorized according to the International Classification of Diseases criteria. RESULTS From 2014 to 2023, we collected data on 1,251 SSIs associated with 56,617 SPs. SSI rates were significantly higher in SPs of INICC compared to CDC/NHSN data: hip prosthesis (3.68% vs 0.67%, relative risk [RR]=5.46, 95% confidence interval [CI]=3.71-8.03, P<.001), knee prosthesis (2.02% vs 0.58%, RR=3.49, 95% CI=1.87-6.49, P<.001), coronary artery bypass (4.16% vs 1.37%, RR=3.03, 95% CI=2.35-3.91, P<.001), peripheral vascular bypass (15.69% vs 2.93%, RR=5.35, 95% CI=2.30-12.48, P<.001), abdominal aortic aneurysm repair (8.51% vs 2.12%, RR=4.02, 95% CI=2.11-7.65, P<.001), spinal fusion (6.47% vs 0.70%, RR=9.27, 95% CI=6.21-13.84, P<.001), laminectomy (2.68% vs 0.72%, RR=3.75, 95% CI=2.36-5.95, P<.001), among others. CONCLUSIONS Elevated SSI rates in LRCs emphasize the need for effective interventions.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA, Miami, FL, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Estuardo Salgado
- Department of Infection Control, Marie Curie Hospital, Quito, Ecuador
| | - Amani El-Kholy
- Department of Infection Control, Cairo University Dar Alfouad Hospital, 6th of October City, Egypt
| | - Julio C Zuniga Moya
- Department of Infection Control, Hospital Noroccidental Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Priyanka Patil
- Department of Infection Control, Breach Candy Hospital Trust, Mumbai, India
| | - Gita Nadimpalli
- Department of Infection Control, Rao Nursing Home, Pune, India
| | | | - Dolatsinh Zala
- Department of Infection Control, School of Applied Science and Technology, Gujrat Technological University, Ahmedabad, India
| | | | - Bat-Erdene Ider
- Department of Infection Control, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Nellie Tumu
- Department of Infection Control, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Wieslawa Duszynska
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Le Thi Thu Nguyet
- Department of Infection Control, Thanh Nhan Hospital, Hanoi, Vietnam
| | - Pravin K Nair
- Department of Infection Control, Holy Spirit Hospital, Mumbai, India
| | - Ziad A Memish
- Department of Infection Control, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
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Rosenthal VD, Jin Z, Yin R, Sahu S, Rajhans P, Kharbanda M, Nair PK, Mishra SB, Chawla R, Arjun R, Sandhu K, Rodrigues C, Dongol R, Myatra SN, Mohd-Basri MN, Chian-Wern T, Bhakta A, Bat-Erdene I, Acharya SP, Alvarez GA, Moreno LAA, Gomez K, da Jimenez-Alvarez LF, Henao-Rodas CM, Valderrama-Beltran SL, Zuniga-Chavarria MA, Aguirre-Avalos G, Hernandez-Chena BE, Sassoe-Gonzalez A, Aleman-Bocanegra MC, Villegas-Mota MI, De Moros DA, Castaneda-Sabogal A, Carreazo NY, Alkhawaja S, Agha HM, El-Kholy A, Abdellatif-Daboor M, Dursun O, Okulu E, Havan M, Yildizdas D, Deniz SSO, Guclu E, Hlinkova S, Ikram A, Tao L, Omar AA, Elahi N, Memish ZA, Petrov MM, Raka L, Janc J, Horhat-Florin G, Medeiros EA, Salgado E, Dueñas L, Coloma M, Perez V, Brown EC. Assessing the impact of a multidimensional approach and an 8-component bundle in reducing incidences of ventilator-associated pneumonia across 35 countries in Latin America, Asia, the Middle East, and Eastern Europe. J Crit Care 2024; 80:154500. [PMID: 38128216 DOI: 10.1016/j.jcrc.2023.154500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Ventilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal. METHODS We implemented a multidimensional approach and an 8-component bundle in 374 ICUs across 35 low and middle-income countries (LMICs) from Latin-America, Asia, Eastern-Europe, and the Middle-East, to reduce VAP rates in ICUs. The VAP rate per 1000 mechanical ventilator (MV)-days was measured at baseline and during intervention at the 2nd month, 3rd month, 4-15 month, 16-27 month, and 28-39 month periods. RESULTS 174,987 patients, during 1,201,592 patient-days, used 463,592 MV-days. VAP per 1000 MV-days rates decreased from 28.46 at baseline to 17.58 at the 2nd month (RR = 0.61; 95% CI = 0.58-0.65; P < 0.001); 13.97 at the 3rd month (RR = 0.49; 95% CI = 0.46-0.52; P < 0.001); 14.44 at the 4-15 month (RR = 0.51; 95% CI = 0.48-0.53; P < 0.001); 11.40 at the 16-27 month (RR = 0.41; 95% CI = 0.38-0.42; P < 0.001), and to 9.68 at the 28-39 month (RR = 0.34; 95% CI = 0.32-0.36; P < 0.001). The multilevel Poisson regression model showed a continuous significant decrease in incidence rate ratios, reaching 0.39 (p < 0.0001) during the 28th to 39th months after implementation of the intervention. CONCLUSIONS This intervention resulted in a significant VAP rate reduction by 66% that was maintained throughout the 39-month period.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Prasad Rajhans
- Deenanath Mangeshkar Hospital and Research Center Erandwane Pune, Pune, India
| | | | | | | | - Rajesh Chawla
- Indraprastha Apollo Hospital Delhi, New Delhi, India
| | | | - Kavita Sandhu
- Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Camilla Rodrigues
- Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Mat Nor Mohd-Basri
- International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan, Malaysia
| | - Tai Chian-Wern
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Arpita Bhakta
- University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nilton Yhuri Carreazo
- Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
| | | | - Hala Mounir Agha
- Cairo University Specialized Pediatric Hospital Cardio Thoracic Icu, Cairo, Egypt
| | | | | | - Oguz Dursun
- Akdeniz University Medical School, Antalya, Turkey
| | - Emel Okulu
- Ankara University Faculty of Medicine Childrens Hospital NICU, Ankara, Turkey
| | - Merve Havan
- Ankara University Faculty of Medicine, Ankara, Turkey
| | | | | | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Sona Hlinkova
- Catholic University in Ruzomberok Faculty of Health Central Military Hospital Snp Ruzomberok, Ruzomberok, Slovakia
| | - Aamer Ikram
- Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - Lili Tao
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Abeer Aly Omar
- Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait
| | | | - Ziad A Memish
- King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Bulgaria
| | - Lul Raka
- National Institute for Public Health, Prishtina, Kosovo
| | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | - George Horhat-Florin
- University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
| | | | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Monica Coloma
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Valentina Perez
- Department of Biological Sciences, Florida International University, Miami, Fl, USA
| | - Eric Christopher Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Rosenthal VD, Yin R, Jin Z, Perez V, Kis MA, Abdulaziz-Alkhawaja S, Valderrama-Beltran SL, Gomez K, Rodas CMH, El-Sisi A, Sahu S, Kharbanda M, Rodrigues C, Myatra SN, Chawla R, Sandhu K, Mehta Y, Rajhans P, Arjun R, Tai CW, Bhakta A, Mat Nor MB, Aguirre-Avalos G, Sassoe-Gonzalez A, Bat-Erdene I, Acharya SP, Aguilar-de-Moros D, Carreazo NY, Duszynska W, Hlinkova S, Yildizdas D, Kılıc EK, Dursun O, Odek C, Deniz SSO, Guclu E, Koksal I, Medeiros EA, Petrov MM, Tao L, Salgado E, Dueñas L, Daboor MA, Raka L, Omar AA, Ikram A, Horhat-Florin G, Memish ZA, Brown EC. Examining the impact of a 9-component bundle and the INICC multidimensional approach on catheter-associated urinary tract infection rates in 32 countries across Asia, Eastern Europe, Latin America, and the Middle East. Am J Infect Control 2024:S0196-6553(24)00105-6. [PMID: 38437883 DOI: 10.1016/j.ajic.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Catheter-Associated Urinary Tract Infections (CAUTIs) frequently occur in the intensive care unit (ICU) and are correlated with a significant burden. METHODS We implemented a strategy involving a 9-element bundle, education, surveillance of CAUTI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CAUTI rates and performance feedback. This was executed in 299 ICUs across 32 low- and middle-income countries. The dependent variable was CAUTI per 1,000 UC days, assessed at baseline and throughout the intervention, in the second month, third month, 4 to 15 months, 16 to 27 months, and 28 to 39 months. Comparisons were made using a 2-sample t test, and the exposure-outcome relationship was explored using a generalized linear mixed model with a Poisson distribution. RESULTS Over the course of 978,364 patient days, 150,258 patients utilized 652,053 UC-days. The rates of CAUTI per 1,000 UC days were measured. The rates decreased from 14.89 during the baseline period to 5.51 in the second month (risk ratio [RR] = 0.37; 95% confidence interval [CI] = 0.34-0.39; P < .001), 3.79 in the third month (RR = 0.25; 95% CI = 0.23-0.28; P < .001), 2.98 in the 4 to 15 months (RR = 0.21; 95% CI = 0.18-0.22; P < .001), 1.86 in the 16 to 27 months (RR = 0.12; 95% CI = 0.11-0.14; P < .001), and 1.71 in the 28 to 39 months (RR = 0.11; 95% CI = 0.09-0.13; P < .001). CONCLUSIONS Our intervention, without substantial costs or additional staffing, achieved an 89% reduction in CAUTI incidence in ICUs across 32 countries, demonstrating feasibility in ICUs of low- and middle-income countries.
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Affiliation(s)
- Victor D Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Infection Control, INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | - Valentina Perez
- Department of Biological Sciences, Florida International University, Miami, USA
| | - Matthew A Kis
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | | | - Sandra L Valderrama-Beltran
- Department of Infection Control, Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
| | - Katherine Gomez
- Department of Infection Control, Clinica Sebastian de Belalcazar, Cali, Colombia
| | - Claudia M H Rodas
- Department of Infection Control, Fundacion Hospital San Jose De Buga, Guadalajara de Buga, Colombia
| | - Amal El-Sisi
- Department of Pediatric Cardiac ICU, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Suneeta Sahu
- Department of Critical Care, Apollo Hospital Bhubaneswar, Bhubaneswar, India
| | | | - Camilla Rodrigues
- Department of Infection Control, Pd Hinduja National Hospital And Medical Research Centre, Mumbai, India
| | - Sheila N Myatra
- Department of Critical Care, Tata Memorial Hospital Homi Bhabha National Institute, Mumbai, India
| | - Rajesh Chawla
- Department of Critical Care, Indraprastha Apollo Hospital Delhi, New Delhi, India
| | - Kavita Sandhu
- Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Yatin Mehta
- Department of Critical Care, Medanta The Medicity, New Delhi, India
| | - Prasad Rajhans
- Department of Critical Care, Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Rajalakshmi Arjun
- Department of Critical Care, Kerala Institute Of Med Sciences Thiruvananthapuram, Thiruvananthapuram, India
| | - Chian-Wern Tai
- Department of Critical Care, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Arpita Bhakta
- Department of Critical Care, University Malaya Medical Centre Pediatric Intensive Care, Kuala Lampur, Malaysia
| | - Mohd-Basri Mat Nor
- Department of Critical Care, International Islamic University Malaysia Department of Anesthesia and Critical Care, Kuantan, Malaysia
| | - Guadalupe Aguirre-Avalos
- Department of Critical Care, Hospital Civil De Guadalajara Fray Antonio Alcalde Terapia Intensiva, Guadalajara, Mexico
| | - Alejandro Sassoe-Gonzalez
- Department of Infection Control, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Mexico
| | - Ider Bat-Erdene
- Department for Quality and Safety, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Subhash P Acharya
- Department of Infection Control, Grande International Hospital, Kathamandu, Nepal
| | - Daisy Aguilar-de-Moros
- Department of Infection Control, Hospital del Nino Dr Jose Renan Esquivel de Panama, Panama, Panama
| | - Nilton Yhuri Carreazo
- Department of Infection Control, Universidad Peruana de Ciencias Aplicadas Hospital de Emergencias Pediatricas, Lima, Peru
| | - Wieslawa Duszynska
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Sona Hlinkova
- Department of Critical Care, Catholic University In Ruzomberok, Faculty of Health, Central Military Hospital SNP Ruzomberok, Ruzomberok, Slovakia
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Balcali Hospital, Adana, Turkey
| | - Esra K Kılıc
- Department of Critical Care, Ankara Training And Research Hospital, Ankara, Turkey
| | - Oguz Dursun
- Department of Critical Care, Akdeniz University Medical School, Antalya, Turkey
| | - Caglar Odek
- Department of Critical Care, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Suna S O Deniz
- Department of Critical Care, Pamukkale University Hospital, Denizli, Turkey
| | - Ertugrul Guclu
- Department of Critical Care, Sakarya University Training And Research Hospital, Sakarya, Turkey
| | - Iftihar Koksal
- Department of Critical Care, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Eduardo A Medeiros
- Department of Infection Control, Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Lili Tao
- Department of Pneumonology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Estuardo Salgado
- Department of Infection Control, Hospital Marie Curie, Quito, Ecuador
| | - Lourdes Dueñas
- Department of Critical Care, Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Mohammad A Daboor
- Department of Infection Control, King Hussein Cancer Center, Amman, Jordan
| | - Lul Raka
- Department of Public Health, National Institute For Public Health, Prishtina, Kosovo
| | - Abeer A Omar
- Department of Infection Control, Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
| | - Aamer Ikram
- Department of Critical Care, Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - George Horhat-Florin
- Department of Critical Care, University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania,Timisoara, Romania
| | - Ziad A Memish
- Department of Infection Control, King Saud Medical City, Ministry of Health, Ryhad, Saudi Arabia
| | - Eric C Brown
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
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Yin R, Jin Z, Lee BH, Alvarez GA, Stagnaro JP, Valderrama-Beltran SL, Gualtero SM, Jiménez-Alvarez LF, Reyes LP, Henao Rodas CM, Gomez K, Alarcon J, Aguilar Moreno LA, Bravo Ojeda JS, Cano Medina YA, Chapeta Parada EG, Zuniga Chavarria MA, Quesada Mora AM, Aguirre-Avalos G, Mijangos-Méndez JC, Sassoe-Gonzalez A, Millán-Castillo CM, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Hernandez-Chena BE, Jarad RMA, Villegas-Mota MI, Montoya-Malváez M, Aguilar-de-Moros D, Castaño-Guerra E, Córdoba J, Castañeda-Sabogal A, Medeiros EA, Fram D, Dueñas L, Carreazo NY, Salgado E, Rosenthal VD. Prospective cohort study of incidence and risk factors for catheter-associated urinary tract infections in 145 intensive care units of 9 Latin American countries: INICC findings. World J Urol 2023; 41:3599-3609. [PMID: 37823942 DOI: 10.1007/s00345-023-04645-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries. METHODS From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period. RESULTS 31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01-1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01-1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06-1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08-1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75-4.49; p < 0.0001. The periods 2014-2016 and 2017-2019 had significantly higher risks than the period 2020-2022. Suprapubic catheters showed similar risks as indwelling catheters. CONCLUSION The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.
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Affiliation(s)
- Ruijie Yin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA
| | - Zhilin Jin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA
| | | | | | - Juan Pablo Stagnaro
- Instituto Central De Medicina, La Plata, Provincia de Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | - Judith Córdoba
- Hospital del Niño Dr José Renán Esquivel, Panama, Panama
| | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Hospital de Emergencias Pediatricas, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Estuardo Salgado
- Department of Infection Control, Hospital Marie Curie, Quito, Ecuador
| | - Victor Daniel Rosenthal
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA.
- International Nosocomial Infection Control Consortium, INICC Foundation, Miami, USA.
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Rosenthal VD, Jin Z, Valderrama-Beltran SL, Gualtero SM, Linares CY, Aguirre-Avalos G, Mijangos-Méndez JC, Ibarra-Estrada MÁ, Jiménez-Alvarez LF, Reyes LP, Alvarez-Moreno CA, Zuniga-Chavarria MA, Quesada-Mora AM, Gomez K, Alarcon J, Millan-Oñate J, Aguilar-de-Moros D, Castaño-Guerrero E, Córdoba J, Sassoe-Gonzalez A, Millán-Castillo CM, Leyva-Xotlanihua L, Aguilar-Moreno LA, Bravo-Ojeda JS, Gutierrez-Tobar IF, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Flores-Sánchez BM, Cano-Medina YA, Chapeta-Parada EG, Gonzalez-Niño RA, Villegas-Mota MI, Montoya-Malváez M, Cortés-Vázquez MÁ, Medeiros EA, Fram D, Vieira-Escudero D, Dueñas L, Carreazo NY, Salgado E, Yin R. Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections in ICUs of 8 Latin American countries. Am J Infect Control 2023; 51:1114-1119. [PMID: 36921694 DOI: 10.1016/j.ajic.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. METHODS From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR). RESULTS About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P < .0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P < .0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P < .0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P < .0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P < .0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P < .0001). PICC (aOR=1.25;95%CI=0.63-2.51; P = .52) was not associated with CLABSI risk. CONCLUSIONS Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, FL, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Miguel Ángel Ibarra-Estrada
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | - Judith Córdoba
- Hospital del Niño Dr José Renán Esquivel, Panama, Panama
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Hospital de Emergencias Pediatricas, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Rosenthal VD, Yin R, Myatra SN, Memish ZA, Rodrigues C, Kharbanda M, Valderrama-Beltran SL, Mehta Y, Afeef Al-Ruzzieh M, Aguirre-Avalos G, Guclu E, Gan CS, Jiménez Alvarez LF, Chawla R, Hlinkova S, Arjun R, Agha HM, Zuniga Chavarria MA, Davaadagva N, Lai YH, Gomez K, Aguilar-de-Moros D, Tai CW, Sassoe Gonzalez A, Aguilar Moreno LA, Sandhu K, Janc J, Aleman Bocanegra MC, Yildizdas D, Cano Medina YA, Villegas Mota MI, Omar AA, Duszynska W, El-Kholy AA, Alkhawaja SA, Florin GH, Medeiros EA, Tao L, Tumu N, Elanbya MG, Dongol R, Mioljević V, Raka L, Dueñas L, Carreazo NY, Dendane T, Ikram A, Kardas T, Petrov MM, Bouziri A, Viet-Hung N, Belskiy V, Elahi N, Salgado E, Jin Z. Multinational prospective study of incidence and risk factors for central-line-associated bloodstream infections in 728 intensive care units of 41 Asian, African, Eastern European, Latin American, and Middle Eastern countries over 24 years. Infect Control Hosp Epidemiol 2023:1-11. [PMID: 37114756 DOI: 10.1017/ice.2023.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To identify central-line (CL)-associated bloodstream infection (CLABSI) incidence and risk factors in low- and middle-income countries (LMICs). DESIGN From July 1, 1998, to February 12, 2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms. SETTING The study included 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern European, Latin American, and Middle Eastern countries. PATIENTS In total, 278,241 patients followed during 1,815,043 patient days acquired 3,537 CLABSIs. METHODS For the CLABSI rate, we used CL days as the denominator and the number of CLABSIs as the numerator. Using multiple logistic regression, outcomes are shown as adjusted odds ratios (aORs). RESULTS The pooled CLABSI rate was 4.82 CLABSIs per 1,000 CL days, which is significantly higher than that reported by the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed 11 variables, and the following variables were independently and significantly associated with CLABSI: length of stay (LOS), risk increasing 3% daily (aOR, 1.03; 95% CI, 1.03-1.04; P < .0001), number of CL days, risk increasing 4% per CL day (aOR, 1.04; 95% CI, 1.03-1.04; P < .0001), surgical hospitalization (aOR, 1.12; 95% CI, 1.03-1.21; P < .0001), tracheostomy use (aOR, 1.52; 95% CI, 1.23-1.88; P < .0001), hospitalization at a publicly owned facility (aOR, 3.04; 95% CI, 2.31-4.01; P <.0001) or at a teaching hospital (aOR, 2.91; 95% CI, 2.22-3.83; P < .0001), hospitalization in a middle-income country (aOR, 2.41; 95% CI, 2.09-2.77; P < .0001). The ICU type with highest risk was adult oncology (aOR, 4.35; 95% CI, 3.11-6.09; P < .0001), followed by pediatric oncology (aOR, 2.51;95% CI, 1.57-3.99; P < .0001), and pediatric (aOR, 2.34; 95% CI, 1.81-3.01; P < .0001). The CL type with the highest risk was internal-jugular (aOR, 3.01; 95% CI, 2.71-3.33; P < .0001), followed by femoral (aOR, 2.29; 95% CI, 1.96-2.68; P < .0001). Peripherally inserted central catheter (PICC) was the CL with the lowest CLABSI risk (aOR, 1.48; 95% CI, 1.02-2.18; P = .04). CONCLUSIONS The following CLABSI risk factors are unlikely to change: country income level, facility ownership, hospitalization type, and ICU type. These findings suggest a focus on reducing LOS, CL days, and tracheostomy; using PICC instead of internal-jugular or femoral CL; and implementing evidence-based CLABSI prevention recommendations.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
- INICC Foundation, International Nosocomial Infection Control Consortium, Miami, Florida, United States
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | | | - Ziad A Memish
- King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Camilla Rodrigues
- Pd Hinduja National Hospital And Medical Research Centre, Mumbai, India
| | | | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Chin Seng Gan
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | - Sona Hlinkova
- Faculty of Health, Catholic University in Ruzomberok, Ruzomberok, Slovakia
- Central Military Hospital Ruzomberok, Ruzomberok, Slovakia
| | | | | | | | | | - Yin Hoong Lai
- International Islamic University Malaysia, Kuantan Pahang, Malaysia
| | | | | | - Chian-Wern Tai
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | | | | | - Kavita Sandhu
- Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | | | | | | | | | - Abeer Aly Omar
- Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
| | - Wieslawa Duszynska
- Wroclaw Medical University. Department of Anesthesiology and Intensive Therapy, Wroclaw, Poland
| | | | | | - George Horhat Florin
- University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
- Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
| | | | - Lili Tao
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nellie Tumu
- Port Moresby General Hospital, Port Moresby, Papua, New Guinea
| | | | | | | | - Lul Raka
- National Institute For Public Health, Prishtina, Kosovo
| | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Hospital de Emergencias Pediatricas, Lima, Peru
| | | | - Aamer Ikram
- National Institutes of Health, Islamabad, Pakistan
| | - Tala Kardas
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | | | | | | | | | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
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Matas-García A, Téllez A, Fernández S, Salgado E, Castro P. Intranasal disulfiram-induced encephalopathy: clinical and neuroimage findings. Rev Neurol 2022; 75:357-360. [PMID: 36440748 PMCID: PMC10280740 DOI: 10.33588/rn.7511.2021415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Disulfiram-induced-encephalopathy is a rare complication that has been well described in adults. Although it usually occurs in acute intoxication with high doses of disulfiram, late onset encephalopathy has also been reported. Some authors propose the inhibition of dopamine beta-hydroxylase mediated by toxic metabolites of disulfiram as the main responsible, but the exact mechanism remains unclear. The aim of this report was to describe the clinical and neuroimaging findings in an unusual case of acute encephalitis due to disulfiram toxicity associated to chronic intranasal consume. CASE REPORT A chronic alcoholic who referred snorted use of a very high dose of disulfiram without simultaneous alcohol intake developed an acute encephalopathy with a rapidly progressive respiratory failure. A characteristic neuroimage finding consisting in extensive bilateral symmetric involvement of both pallidal nuclei was described. Recovery and neurologic improvement were slow. Two months after the intoxication, the patient still had slight intentional tremor and a scheduled magnetic resonance imaging. showed evolution of symmetrical areas of cytotoxic edema to necrosis. CONCLUSION Disulfiram-induced neurotoxicity must be suspect during chronic therapy with disulfiram or after acute ingestion of high doses. Symptoms such as symmetric sensory and motor neuropathy, confusion, catatonia, parkinsonism, ataxia, choreoathetosis, seizures and encephalopathy should make us rule out this disorder. A brain imaging test should be performed in these patients since a characteristic involvement of both nuclei pallidus has been described, but it is not present in all patients.
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Affiliation(s)
| | - A Téllez
- Hospital Clínic de Barcelona, 08036 Barcelona, España
| | - S Fernández
- Hospital Clínic de Barcelona, 08036 Barcelona, España
| | - E Salgado
- Hospital Clínic de Barcelona, 08036 Barcelona, España
| | - P Castro
- Hospital Clínic de Barcelona, 08036 Barcelona, España
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Arraras J, Illarramendi J, Manterola-Burgaleta A, de la Cruz S, Zarandona U, Ibañez B, Salgado E, Visus I, Barrado M, Teijeira L, Martinez E, Vera R. Quality of Life of breast cancer patients with COVID-19 disease. Eur J Cancer 2022. [PMCID: PMC9671787 DOI: 10.1016/s0959-8049(22)01515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- J.I. Arraras
- Servicio Navarro de Salud/Complejo Hospitalario de Navarra, Oncology Departments, Pamplona, Spain
| | - J.J. Illarramendi
- Hospital Universitario de Navarra, Medical Oncology, Pamplona, Spain
| | | | - S. de la Cruz
- Hospital Universitario de Navarra, Medical Oncology, Pamplona, Spain
| | - U. Zarandona
- Hospital Universitario de Navarra, Oncology Departments, Pamplona, Spain
| | - B. Ibañez
- Navarrabiomed- Departamento de Salud-UPNA, Methodology, Pamplona, Spain
| | - E. Salgado
- Hospital Universitario de Navarra, Medical Oncology, Pamplona, Spain
| | - I. Visus
- Hospital Universitario de Navarra, Radiotherapeutic Oncology, Pamplona, Spain
| | - M. Barrado
- Hospital Universitario de Navarra, Radiotherapeutic Oncology, Pamplona, Spain
| | - L. Teijeira
- Hospital Universitario de Navarra, Medical Oncology, Pamplona, Spain
| | - E. Martinez
- Hospital Universitario de Navarra, Radiotherapeutic Oncology, Pamplona, Spain
| | - R. Vera
- Hospital Universitario de Navarra, Medical Oncology, Pamplona, Spain
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Escudero D, Astola I, Balboa S, Leoz B, Meilan Á, Del Busto C, Quindós B, Forcelledo L, Vizcaino D, Martín L, Salgado E, Viña L. Clinico-radiological related to early brain death factors. Med Intensiva 2021; 46:1-7. [PMID: 34802992 DOI: 10.1016/j.medine.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 h. DESIGN A retrospective cohort study was made covering the period 2015-2017. SETTING An adult Intensive Care Unit (ICU). PATIENTS/METHODS Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD. RESULTS A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD > 24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD > 24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD > 24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups. CONCLUSIONS Early BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.
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Affiliation(s)
- D Escudero
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - I Astola
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - S Balboa
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - B Leoz
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Á Meilan
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - C Del Busto
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - B Quindós
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L Forcelledo
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - D Vizcaino
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L Martín
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - E Salgado
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L Viña
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
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du Fay de Lavallaz J, Badertscher P, Zimmermann T, Nestelberger T, Walter J, Strebel I, Coelho C, Miró Ò, Salgado E, Christ M, Geigy N, Cullen L, Than M, Javier Martin-Sanchez F, Di Somma S, Frank Peacock W, Morawiec B, Wussler D, Keller DI, Gualandro D, Michou E, Kühne M, Lohrmann J, Reichlin T, Mueller C. Early standardized clinical judgement for syncope diagnosis in the emergency department. J Intern Med 2021; 290:728-739. [PMID: 33755279 DOI: 10.1111/joim.13269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/16/2020] [Accepted: 01/08/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The diagnosis of cardiac syncope remains a challenge in the emergency department (ED). OBJECTIVE Assessing the diagnostic accuracy of the early standardized clinical judgement (ESCJ) including a standardized syncope-specific case report form (CRF) in comparison with a recommended multivariable diagnostic score. METHODS In a prospective international observational multicentre study, diagnostic accuracy for cardiac syncope of ESCJ by the ED physician amongst patients ≥ 40 years presenting with syncope to the ED was directly compared with that of the Evaluation of Guidelines in Syncope Study (EGSYS) diagnostic score. Cardiac syncope was centrally adjudicated independently of the ESCJ or conducted workup by two ED specialists based on all information available up to 1-year follow-up. Secondary aims included direct comparison with high-sensitivity cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP) concentrations and a Lasso regression to identify variables contributing most to ESCJ. RESULTS Cardiac syncope was adjudicated in 252/1494 patients (15.2%). The diagnostic accuracy of ESCJ for cardiac syncope as quantified by the area under the curve (AUC) was 0.87 (95% CI: 0.84-0.89), and higher compared with the EGSYS diagnostic score (0.73 (95% CI: 0.70-0.76)), hs-cTnI (0.77 (95% CI: 0.73-0.80)) and BNP (0.77 (95% CI: 0.74-0.80)), all P < 0.001. Both biomarkers (alone or in combination) on top of the ESCJ significantly improved diagnostic accuracy. CONCLUSION ESCJ including a standardized syncope-specific CRF has very high diagnostic accuracy and outperforms the EGSYS score, hs-cTnI and BNP.
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Affiliation(s)
- J du Fay de Lavallaz
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - P Badertscher
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - T Zimmermann
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - T Nestelberger
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - J Walter
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - I Strebel
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - C Coelho
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - Ò Miró
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Hospital Clinic, Barcelona, Catalonia, Spain
| | - E Salgado
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Hospital Clinic, Barcelona, Catalonia, Spain
| | - M Christ
- Department of Emergency Medicine, Kantonsspital, Luzern, Switzerland
| | - N Geigy
- Department of Emergency Medicine, Hospital of Liestal, Liestal, Switzerland
| | - L Cullen
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Royal Brisbane & Women's Hospital, Herston, Australia
| | - M Than
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Christchurch Hospital, Christchurch, New Zealand
| | - F Javier Martin-Sanchez
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain
| | - S Di Somma
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | - W Frank Peacock
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - B Morawiec
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - D Wussler
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - D I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - D Gualandro
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - E Michou
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - M Kühne
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - J Lohrmann
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - T Reichlin
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Cardiology, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - C Mueller
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | -
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
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12
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Blondon M, Jimenez D, Robert‐Ebadi H, Del Toro J, Lopez‐Jimenez L, Falga C, Skride A, Font L, Vazquez FJ, Bounameaux H, Monreal M, Prandoni P, Brenner, B, Farge‐Bancel D, Barba R, Di Micco P, Bertoletti L, Schellong S, Tzoran I, Reis A, Bosevski M, Malý R, Verhamme P, Caprini JA, My Bui H, Adarraga MD, Agud M, Aibar J, Aibar MA, Alfonso J, Amado C, Arcelus JI, Baeza C, Ballaz A, Barba R, Barbagelata C, Barrón M, Barrón‐Andrés B, Blanco‐Molina A, Botella E, Camon AM, Castro J, Caudevilla MA, Cerdà P, Chasco L, Criado J, de Ancos C, de Miguel J, Demelo‐Rodríguez P, Díaz‐Peromingo JA, Díez‐Sierra J, Díaz‐Simón R, Domínguez IM, Encabo M, Escribano JC, Falgá C, Farfán AI, Fernández‐Capitán C, Fernández‐Reyes JL, Fidalgo MA, Flores K, Font C, Francisco I, Gabara C, Galeano‐Valle F, García MA, García‐Bragado F, García‐Mullor MM, Gavín‐Blanco O, Gavín‐Sebastián O, Gil‐Díaz A, Gómez‐Cuervo C, González‐Martínez J, Grau E, Guirado L, Gutiérrez J, Hernández‐Blasco L, Jara‐Palomares L, Jaras MJ, Jiménez D, Joya MD, Jou I, Lacruz B, Lecumberri R, Lima J, Lobo JL, López‐Brull H, López‐Jiménez L, López‐Miguel P, López‐Núñez JJ, López‐Reyes R, López‐Sáez JB, Lorente MA, Lorenzo A, Loring M, Madridano O, Maestre A, Marchena PJ, Martín del Pozo M, Martín‐Martos F, Martínez‐Baquerizo C, Mella C, Mellado M, Mercado MI, Moisés J, Morales MV, Muñoz‐Blanco A, Muñoz‐Guglielmetti D, Muñoz‐Rivas N, Nart E, Nieto JA, Núñez MJ, Olivares MC, Ortega‐Michel C, Ortega‐Recio MD, Osorio J, Otalora S, Otero R, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez‐Jacoiste A, Peris ML, Pesántez D, Porras JA, Portillo J, Reig L, Riera‐Mestre A, Rivas A, Rodríguez‐Cobo A, Rodríguez‐Matute C, Rogado J, Rosa V, Rubio CM, Ruiz‐Artacho P, Ruiz‐Giménez N, Ruiz‐Ruiz J, Ruiz‐Sada P, Sahuquillo JC, Salgueiro G, Sampériz A, Sánchez‐Muñoz‐Torrero JF, Sancho T, Sigüenza P, Sirisi M, Soler S, Suárez S, Suriñach JM, Tiberio G, Torres MI, Tolosa C, Trujillo‐Santos J, Uresandi F, Usandizaga E, Valle R, Vela JR, Vidal G, Vilar C, Villares P, Zamora C, Gutiérrez P, Vázquez FJ, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bertoletti L, Bura‐Riviere A, Crichi B, Debourdeau P, Espitia O, Farge‐Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Ciammaichella M, Colaizzo D, Dentali F, Di Micco P, Giammarino E, Grandone E, Mangiacapra S, Mastroiacovo D, Maida R, Mumoli N, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tufano A, Visonà A, Vo Hong N, Zalunardo B, Kalejs RV, Maķe K, Ferreira M, Fonseca S, Martins F, Meireles J, Bosevski M, Zdraveska M, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, Bui HM. Comparative clinical prognosis of massive and non-massive pulmonary embolism: A registry-based cohort study. J Thromb Haemost 2021; 19:408-416. [PMID: 33119949 DOI: 10.1111/jth.15146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
AIMS Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation. METHODS AND RESULTS We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (<90 mm Hg). We compared the risks of recurrent VTE, major bleeding, and mortality using time-to-event multivariable competing risk modeling. There were 3.5% of massive PE among 38 996 patients with PE. During the anticoagulation period, massive PE was associated with a greater risk of major bleeding (subhazard ratio [sHR] 1.72, 95% confidence interval [CI] 1.28-2.32), but not of recurrent VTE (sHR 1.15, 95% CI 0.75-1.74) than non-massive PE. An increased risk of mortality was only observed in the first month after PE. After discontinuation of anticoagulation, among 11 579 patients, massive PE and non-massive PE had similar risks of mortality, bleeding, and recurrent VTE (sHR 0.85, 95% CI 0.51-1.40), but with different case fatality of recurrent PE (11.1% versus 2.4%, P = .03) and possibly different risk of recurrent fatal PE (sHR 3.65, 95% CI 0.82-16.24). CONCLUSION In this large prospective registry, the baseline hemodynamic status of the incident PE did not influence the risk of recurrent VTE, during and after the anticoagulation periods, but was possibly associated with recurrent PE of greater severity.
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Affiliation(s)
- Marc Blondon
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - David Jimenez
- Respiratory Department Hospital Ramón y Cajal and Medicine Department Universidad de Alcalá (IRYCIS) Madrid Spain
| | - Helia Robert‐Ebadi
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Jorge Del Toro
- Department of Internal Medicine Hospital General Universitario Gregorio Marañón Madrid Spain
| | | | - Conxita Falga
- Department of Internal Medicine Hospital de Mataro Barcelona Spain
| | - Andris Skride
- Department of Cardiology Ospedale Pauls Stradins Clinical University Hospital Riga Latvia
| | - Llorenç Font
- Department of Haematology Hospital de Tortosa Verge de la Cinta Tarragona Spain
| | | | - Henri Bounameaux
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Manuel Monreal
- Department of Internal Medicine Hospital Germans Trias i Pujol Badalona Spain
- Universidad Catolica de Murcia Murcia Spain
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13
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Arraras J, Manterola A, Illarramendi J, Asin G, Campo M, De la Cruz S, Zarandona U, Ibañez B, Rico M, Salgado E, Dominguez M, Barrado M, Martinez E. PO-1287: Quality of life (QL) in elderly breast cancer survivors. Effects of surgery. Global QL determinants. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Arraras J, Illarramendi J, Manterola A, De la Cruz S, Asin G, Salgado E, Campos M, Barrado M, Ibañez B, Zarandona U, Rico M, Dominguez M, Sola A, Martinez E. Quality of life (QL) in elderly breast cancer survivors. Effects of surgery. Global QL determinants. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Escudero D, Astola I, Balboa S, Leoz B, Meilan Á, Del Busto C, Quindós B, Forcelledo L, Vizcaino D, Martín L, Salgado E, Viña L. Clinico-radiological related to early brain death factors. Med Intensiva 2020; 46:S0210-5691(20)30249-7. [PMID: 32873408 DOI: 10.1016/j.medin.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 hours. DESIGN A retrospective cohort study was made covering the period 2015-2017. SETTING An adult Intensive Care Unit (ICU). PATIENTS/METHODS Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD. RESULTS A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD >24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD >24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD >24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups. CONCLUSIONS Early BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.
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Affiliation(s)
- D Escudero
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España.
| | - I Astola
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - S Balboa
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - B Leoz
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - Á Meilan
- Sección de Neurorradiología, Servicio de Radiología. Hospital Universitario Central de Asturias, Oviedo, España
| | - C Del Busto
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - B Quindós
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - L Forcelledo
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - D Vizcaino
- Sección de Neurorradiología, Servicio de Radiología. Hospital Universitario Central de Asturias, Oviedo, España
| | - L Martín
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - E Salgado
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - L Viña
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
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16
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Mehdipoor G, Jimenez D, Bertoletti L, Fidalgo Á, Sanchez Muñoz-Torrero JF, Gonzalez-Martinez JP, Blanco-Molina Á, Ángel Aibar M, Bonnefoy PB, Khorasani R, Prince MR, Bikdeli B, Monreal M, Adarraga MD, Agud M, Azcarate-Agüero P, Aibar J, Alfonso J, Amado C, Ignacio Arcelus J, Ballaz A, Barba R, Barrón CBM, Barrón-Andrés B, Camon AM, Cañas I, Criado J, Ancos CD, Miguel JD, del Toro J, Demelo-Rodríguez P, Díaz-Pedroche C, Díaz-Peromingo JA, Díaz-Simón R, Díez-Sierra J, Milagros Domínguez I, Escribano JC, Farfán AI, Fernández-Capitán C, Fernández-Reyes JL, Flores K, Font C, Font L, Francisco I, Gabara C, Galeano-Valle F, Ángeles García M, García-Bragado F, García-García M, García-Raso A, Gavín-Blanco O, Gavín-Sebastián O, Carmen Gayol M, Gil-Díaz A, Gómez-Cuervo C, Grau E, Gutiérrez-Guisado J, Hernández-Blasco L, Iglesias M, Jara-Palomares L, Jesús Jaras M, Joya MD, Jou I, Lacruz B, Lalueza A, Lecumberri R, Lima J, Llamas P, Luis Lobo J, López-Jiménez L, López-Miguel P, José López-Núñez J, López-Reyes R, Bosco López-Sáez J, Alejandro Lorente M, Lorenzo A, Loring M, Lumbierres M, Madridano O, Maestre A, Javier Marchena P, Martín-Fernández M, Miguel Martín-Guerra J, Martín-Martos F, Mellado M, Mercado MI, Moisés J, del Valle Morales M, Muñoz-Blanco A, Muñoz-Guglielmetti D, Antonio Nieto J, Jesús Núñez M, Ortega-Michel MCOC, Dolores Ortega-Recio M, Osorio J, Otero R, Paredes D, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez-Ductor C, Asunción Pérez-Jacoíste M, Pesántez D, Porras JA, Portillo J, Reig L, Riera-Mestre A, Rivas A, Rodríguez-Cobo A, Rodríguez-Galán I, Rodríguez-Matute C, Rosa V, María Rubio C, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Ruiz J, Ruiz-Sada P, Ruiz-Torregrosa P, Carles Sahuquillo J, Salgueiro G, Sampériz Á, Sancho T, Soler S, Suárez S, María Suriñach J, Tiberio G, Isabel Torres M, Tolosa C, Trujillo-Santos J, Uresandi F, Usandizaga E, Valle R, Ramón Vela J, Vidal G, Villares P, Zamora C, Gutiérrez P, Javier Vázquez F, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bura-Riviere A, Crichi B, Debourdeau P, Farge-Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Bucherini E, Ciammaichella M, Colaizzo D, Dentali F, Micco PD, Giammarino E, Grandone E, Maggi F, Mangiacapra S, Mastroiacovo D, Maida R, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tiraferri E, Tufano A, Visonà A, Hong NV, Zalunardo B, Kalejs RV, Kigitovica D, Skride A, Ferreira M, Meireles J, Reis A, Bosevski M, Krstevski G, Zdraveska M, Bounameaux H, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, My Bui H. Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism. Circ Cardiovasc Imaging 2020; 13:e010651. [DOI: 10.1161/circimaging.120.010651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The choice of the imaging modality for diagnosis of pulmonary embolism (PE) could be influenced by provider, patient or hospital characteristics, or over time. However, little is known about the choice of the diagnostic modalities in practice. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE.
Methods:
Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001–January 2019), we explored the imaging modalities used in patients with acute PE. The imaging modalities included computed tomography pulmonary angiography, ventilation/perfusion scanning, pulmonary angiography, a combination of these tests, or PE signs and symptoms plus imaging-confirmed proximal deep vein thrombosis but no chest imaging.
Results:
Among 38 025 patients with confirmed PE (53.1% female, age: 67.3±17 years), computed tomography pulmonary angiography was the dominant modality of diagnosis in all RIETE enrollees (78.2% [99% CI, 77.6–78.7]); including pregnant patients (58.9% [99% CI, 47.7%–69.4%]) and patients with severe renal insufficiency (62.5% [99% CI, 59.9–65.0]). A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%,
P
<0.001). The use of computed tomography pulmonary angiography varied between 13.3% and 98.3% across the countries, and its use increased over time (46.5% in 2002 to 91.7% in 2018,
P
<0.001).
Conclusions:
In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The safety, costs, and downstream effects of these tests on PE-related and non-PE-related outcomes warrant further investigation.
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Affiliation(s)
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain (D.J.)
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de Saint-Etienne and INSERM U1059 SAINBIOSE - CIC 1408, Université Jean-Monnet, Saint-Etienne, France (L.B.)
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Spain (A.F.)
| | | | - José Pedro Gonzalez-Martinez
- Department of Internal Medicine, Hospital Universitari St Joan de Deu Manresa (Barcelona) Fundació Althaia (J.P.G.-M.)
| | - Ángeles Blanco-Molina
- Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain (A.B.-M.)
| | - Miguel Ángel Aibar
- Internal Medicine Department and IIS Aragón, Hospital Clínico Universitario, Zaragoza, Spain (M.A.A.)
| | - Pierre-Benoît Bonnefoy
- Service de médecine nucléaire, Hôpital Nord, CHU de St-Etienne, Saint-Etienne, France (P.-B.B.)
| | - Ramin Khorasani
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.K.)
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital (M.R.P.)
- Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Behnood Bikdeli
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital (B.B.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (B.B.)
- Cardiovascular Research Foundation (CRF), New York, NY (B.B.)
| | - Manuel Monreal
- Department of Internal Medicine, Hospital de Badalona Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain (M.M.)
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Avnery O, Martin M, Bura-Riviere A, Barillari G, Mazzolai L, Mahé I, Marchena PJ, Verhamme P, Monreal M, Ellis MH, Aibar MA, Aibar J, Amado C, Arcelus JI, Ballaz A, Barba R, Barrón M, Barrón‐Andrés B, Bascuñana J, ina A, Camon AM, Cañas I, Carrasco C, Castro J, Ancos C, Toro J, Demelo P, Díaz‐Peromingo JA, Falgá C, Farfán AI, Fernández‐Capitán C, Fernández‐Criado MC, Fernández‐Núñez S, Fidalgo MA, Font C, Font L, Freire M, Gallego M, García MA, García‐Bragado F, García‐Morillo M, García‐Raso A, Gavín O, Gayol MC, Gil‐Díaz A, Gómez V, Gómez‐Cuervo C, González‐Martínez J, Grau E, Gutiérrez J, Hernández‐Blasco LM, Iglesias M, Jara‐Palomares L, Jaras MJ, Jiménez R, Jiménez‐Castro D, Jiménez‐López J, Joya MD, Lima J, Llamas P, Lobo JL, López‐Jiménez L, López‐Miguel P, López‐Núñez JJ, López‐Reyes R, López‐Sáez JB, Lorente MA, Lorenzo A, Loring M, Madridano O, Maestre A, Martín del Pozo M, Martín‐Guerra JM, Martín‐Romero M, Mellado M, Morales MV, Muñoz N, Nieto‐Cabrera MA, Nieto‐Rodríguez JA, Núñez‐Ares A, Núñez MJ, Olivares MC, Otalora S, Otero R, Pedrajas JM, Pellejero G, Pérez‐Rus G, Peris ML, Porras JA, Rivas A, Rodríguez‐Dávila MA, Rodríguez‐Hernández A, Rubio CM, Ruiz‐Artacho P, Ruiz‐Ruiz J, Ruiz‐Torregrosa P, Ruiz‐Sada P, Sahuquillo JC, Salazar V, Sampériz A, Sánchez‐Muñoz‐Torrero JF, Sancho T, Soler S, Sopeña B, Suriñach JM, Tolosa C, Torres MI, Trujillo‐Santos J, Uresandi F, Valle R, Vidal G, Villares P, Gutiérrez P, Vázquez FJ, Vilaseca A, Vanassche T, Vandenbriele C, Hirmerova J, Malý R, Salgado E, Benzidia I, Bertoletti L, Debourdeau P, Farge‐Bancel D, Hij A, Moustafa F, Schellong S, Braester A, Brenner B, Tzoran I, Sharif‐Kashani B, Bilora F, Bortoluzzi C, Bucherini E, Ciammaichella M, Dentali F, Di Micco P, Di Pangrazio M, Maida R, Mastroiacovo D, Pace F, Pallotti G, Parisi R, Pesavento R, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tufano A, Visonà A, Vo Hong N, Gibietis V, Skride A, Strautmane S, Bosevski M, Zdraveska M, Bounameaux H, Fresa M, Ney B, Caprini J, Bui HM, Pham KQ. D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry. J Intern Med 2020; 287:32-41. [PMID: 31394000 DOI: 10.1111/joim.12969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with venous thromboembolism (VTE) secondary to transient risk factors may develop VTE recurrences after discontinuing anticoagulation. Identifying at-risk patients could help to guide the duration of therapy. METHODS We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. Transient risk factors were classified as major (postoperative) or minor (pregnancy, oestrogen use, immobilization or recent travel). RESULTS In December 2018, 1655 VTE patients with transient risk factors (major 460, minor 1195) underwent d-dimer measurements after discontinuing anticoagulation. Amongst patients with major risk factors, the recurrence rate was 5.74 (95% CI: 3.19-9.57) events per 100 patient-years in those with raised d-dimer levels and 2.68 (95% CI: 1.45-4.56) in those with normal levels. Amongst patients with minor risk factors, the rates were 7.79 (95% CI: 5.71-10.4) and 3.34 (95% CI: 2.39-4.53), respectively. Patients with major risk factors and raised d-dimer levels (n = 171) had a nonsignificantly higher rate of recurrences (hazard ratio [HR]: 2.14; 95% CI: 0.96-4.79) than those with normal levels. Patients with minor risk factors and raised d-dimer levels (n = 382) had a higher rate of recurrences (HR: 2.34; 95% CI: 1.51-3.63) than those with normal levels. On multivariate analysis, raised d-dimers (HR: 1.74; 95% CI: 1.09-2.77) were associated with an increased risk for recurrences in patients with minor risk factors, not in those with major risk factors. CONCLUSIONS Patients with raised d-dimer levels after discontinuing anticoagulant therapy for VTE provoked by a minor transient risk factor were at an increased risk for recurrences.
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Affiliation(s)
- O Avnery
- Meir Medical Center, Hematology Institute and Blood Bank, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Martin
- Hospital Infanta Sofia San Sebastian de los Reyes and Universidad Europea de Madrid, Madrid, Spain
| | - A Bura-Riviere
- Department of Vascular Medicine, Hôpital de Rangueil, Toulouse, France
| | - G Barillari
- Department of Internal Medicine, Ospedale S. Maria della Misericordia, Udine, Italy
| | - L Mazzolai
- Department of Angiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - I Mahé
- Department of Internal Medicine, Hôpital Louis Mourier, Colombes (APHP), University Paris 7, Colombes, France
| | - P J Marchena
- Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Deu-Hospital General, Barcelona, Spain
| | - P Verhamme
- Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium
| | - M Monreal
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M H Ellis
- Meir Medical Center, Hematology Institute and Blood Bank, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Arraras JI, Illarramendi JJ, Manterola A, Asin G, Salgado E, Arrondo P, Dominguez MA, Arrazubi V, Martinez E, Viudez A, de la Cruz S, Vera R. Quality of life in elderly breast cancer patients with localized disease receiving endocrine treatment: a prospective study. Clin Transl Oncol 2019; 21:1231-1239. [PMID: 30712234 DOI: 10.1007/s12094-019-02048-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/16/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE In this paper we study the quality of life (QoL) of elderly breast cancer patients receiving endocrine treatment (ET). More QoL data on elderly patients treated with ET are needed. Our aims are to study QoL in early-stage breast cancer patients throughout the treatment period and compare the QoL of ET groups. METHODS 148 patients > 65 years who began ET with either tamoxifen or aromatase inhibitor (AI) completed the EORTC QLQ-C30 and QLQ-BR23 and the Interview for Deterioration in Daily Living Activities in Dementia (IDDD) questionnaires three times over 3 years of ET. Linear mixed-effect models were used to evaluate longitudinal QoL changes. ET group comparisons were conducted after 3 years of treatment via ANCOVA adjusted by basal QoL. RESULTS QoL scores were high (> 80/100 points) in most QoL areas, with moderate limitations (> 30) in sexual functioning and enjoyment and in future perspective. After 3 years of ET, four QoL areas improved (< 6 points) compared to baseline and 3-month assessments. Hot flushes worsened (8 points) at the 3-month assessment but by 3 years had recovered. AI patients showed more hot flushes, pain and diarrhea and less sexual enjoyment than tamoxifen patients after 3 years of ET (differences 3-12 points). CONCLUSIONS Results indicate that elderly early-stage breast cancer patients adapted well to their disease and ET treatment over the 3 years. Few QoL differences were observed between ET groups.
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Affiliation(s)
- J I Arraras
- Medical Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain. .,Radiotherapeutic Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain.
| | - J J Illarramendi
- Medical Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | - A Manterola
- Radiotherapeutic Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | - G Asin
- Radiotherapeutic Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | - E Salgado
- Medical Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | - P Arrondo
- Medical Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain.,Radiotherapeutic Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | - M A Dominguez
- Radiotherapeutic Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | - V Arrazubi
- Medical Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | - E Martinez
- Radiotherapeutic Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | - A Viudez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | - S de la Cruz
- Medical Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
| | - R Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Spain
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Torrente-Segarra V, Salman Monte TC, Rúa-Figueroa I, De Uña-Álvarez J, Balboa-Barreiro V, López-Longo FJ, Galindo-Izquierdo M, Calvo-Alén J, Olivé-Marqués A, Mouriño-Rodríguez C, Horcada L, Sánchez-Atrio A, Montilla C, Salgado E, Díez-Álvarez E, Blanco R, Andreu JL, Fernández-Berrizbeitia O, Hernández-Beriain JA, Gantes M, Hernández-Cruz B, Pecondón-Español A, Marras C, Bonilla G, Pego-Reigosa JM. Relationship between damage and mortality in juvenile-onset systemic lupus erythematosus: Cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry (RELESSER). Semin Arthritis Rheum 2018; 48:1025-1029. [PMID: 30344081 DOI: 10.1016/j.semarthrit.2018.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/21/2018] [Accepted: 09/24/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify patterns (clusters) of damage manifestation within a large cohort of juvenile SLE (jSLE) patients and evaluate their possible association with mortality. METHODS This is a multicentre, descriptive, cross-sectional study of a cohort of 345 jSLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestation were identified and compared. RESULTS Mean age (years) ± S.D. at diagnosis was 14.2 ± 2.89; 88.7% were female and 93.4% were Caucasian. Mean SLICC/ACR DI ± S.D. was 1.27 ± 1.63. A total of 12 (3.5%) patients died. Three damage clusters were identified: Cluster 1 (72.7% of patients) presented a lower number of individuals with damage (22.3% vs. 100% in Clusters 2 and 3, P < 0.001); Cluster 2 (14.5% of patients) was characterized by renal damage in 60% of patients, significantly more than Clusters 1 and 3 (P < 0.001), in addition to increased more ocular, cardiovascular and gonadal damage; Cluster 3 (12.7%) was the only group with musculoskeletal damage (100%), significantly higher than in Clusters 1 and 2 (P < 0.001). The overall mortality rate in Cluster 2 was 2.2 times higher than that in Cluster 3 and 5 times higher than that in Cluster 1 (P < 0.017 for both comparisons). CONCLUSIONS In a large cohort of jSLE patients, renal and musculoskeletal damage manifestations were the two dominant forms of damage by which patients were sorted into clinically meaningful clusters. We found two clusters of jSLE with important clinical damage that were associated with higher rates of mortality, especially for the cluster of patients with predominant renal damage. Physicians should be particularly vigilant to the early prevention of damage in this subset of jSLE patients with kidney involvement.
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Affiliation(s)
- V Torrente-Segarra
- Rheumatology Department, Hospital General Hospitalet-Sant Joan DespíMoisèsBroggi, C/ Josep Molins 29-41, 08906 Hospitalet, Llobregat 08906, Spain.
| | - T C Salman Monte
- Rheumatology Department, Parc de Salut Mar-IMIM, Barcelona, Spain
| | - I Rúa-Figueroa
- Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | | | | | - F J López-Longo
- Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - M Galindo-Izquierdo
- Rheumatology Department, Doce de Octubre University Hospital, Madrid, Spain.
| | - J Calvo-Alén
- Rheumatology Department, Sierrallana Hospital, Torrelavega, Spain.
| | - A Olivé-Marqués
- Rheumatology Department, Germans TríasiPujol University Hospital, Badalona, Spain.
| | - C Mouriño-Rodríguez
- Rheumatology Department, Complexo Hospitalario Universitario de Vigo, Spain.
| | - L Horcada
- Rheumatology Department, Navarra Hospital, Navarra, Pamplona, Spain
| | - A Sánchez-Atrio
- Rheumatology Department, Príncipe de Asturias University Hospital, Madrid, Spain
| | - C Montilla
- Rheumatology Department, Salamanca Clinic University Hospital, Salamanca, Spain
| | - E Salgado
- Rheumatology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
| | | | - R Blanco
- Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain.
| | - J L Andreu
- Rheumatology Department, Puertadel Hierro-Majadahonda Hospital, Madrid, Spain.
| | | | - J A Hernández-Beriain
- José Ángel, Rheumatology Department, Hospital Insular of Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - M Gantes
- RheumatologyDepartment, Tenerife Clinic Hospital, Tenerife, Spain
| | - B Hernández-Cruz
- Rheumatology Department, Virgen Macarena Hospital, Sevilla, Spain
| | - A Pecondón-Español
- RheumatologyDepartment, Miguel Servet University Hospital, Zaragoza, Spain.
| | - C Marras
- RheumatologyDepartment, Virgen de laArrixaca University Hospital, Murcia, Spain
| | - G Bonilla
- RheumatologyDepartment, La Paz University Hospital, Madrid, Spain.
| | - J M Pego-Reigosa
- Rheumatology Department, Complexo Hospitalario Universitario de Vigo, IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain.
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20
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Arraras J, Manterola A, Illarramendi J, Asin G, Salgado E, De la Cruz S, Ibañez B, Vera R, Dominguez M. EP-1265: Quality of Life in long term premenopausic early stages breast cancer survivors. QL determinants. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31575-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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González-Castro A, Ortiz-Lasa M, Leizaola O, Salgado E, Irriguible T, Sánchez-Satorra M, Lomas-Fernández C, Barral-Segade P, Cordero-Vallejo M, Rodrigo-Calabia E, Dierssen-Sotos T. Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case-control study paired by APACHE-II. Rev Esp Anestesiol Reanim 2017; 64:243-249. [PMID: 28196670 DOI: 10.1016/j.redar.2016.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To analyse the association between water balance during the first 24h of admission to ICU and the variables related to chloride levels (chloride loading, type of fluid administered, hyperchloraemia), with the development of acute kidney injury renal replacement therapy (AKI-RRT) during patients' admission to ICU. PATIENTS AND METHODS Multicentre case-control study. Hospital-based, national, carried out in 6 ICUs. Cases were patients older than 18 years who developed an AKI-RRT. Controls were patients older than 18 years admitted to the same institutions during the study period, who did not develop AKI-RRT during ICU admission. Pairing was done by APACHE-II. An analysis of unconditional logistic regression adjusted for age, sex, APACHE-II and water balance (in evaluating the type of fluid). RESULTS We analysed the variables of 430 patients: 215 cases and 215 controls. An increase of 10% of the possibility of developing AKI-RRT per 500ml of positive water balance was evident (OR: 1.09 [95% CI: 1.05 to 1.14]; P<.001). The study of mean values of chloride load administered did not show differences between the group of cases and controls (299.35±254.91 vs. 301.67±234.63; P=.92). CONCLUSIONS The water balance in the first 24h of ICU admission relates to the development of IRA-TRR, regardless of chloraemia.
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Affiliation(s)
- A González-Castro
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - M Ortiz-Lasa
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - O Leizaola
- Servicio de Medicina Intensiva, Hospital Universitario de Cabueñes, Gijón, España
| | - E Salgado
- Servicio de Medicina Intensiva, Hospital Universitario de Cabueñes, Gijón, España
| | - T Irriguible
- Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, España
| | - M Sánchez-Satorra
- Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, España
| | - C Lomas-Fernández
- Servicio de Medicina Intensiva, Hospital Moisés Broggi, Sant Joan Despí, España
| | - P Barral-Segade
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - M Cordero-Vallejo
- Servicio de Medicina Intensiva, Hospital Universitario Araba, Vitoria, España
| | - E Rodrigo-Calabia
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - T Dierssen-Sotos
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, España
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22
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Tzoran I, Papadakis M, Brenner B, Fidalgo Á, Rivas A, Wells PS, Gavín O, Adarraga MD, Moustafa F, Monreal M, Prandoni P, Brenner B, Barba R, Di Micco P, Bertoletti L, Tzoran I, Reis A, Bosevski M, Bounameaux H, Malý R, Wells P, Papadakis M, Adarraga M, Aibar M, Alfonso M, Arcelus J, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Cañada G, Cañas I, Chic N, del Pozo R, del Toro J, Díaz-Pedroche M, Díaz-Peromingo J, Falgá C, Fernández-Capitán C, Fidalgo M, Font C, Font L, Gallego P, García A, García M, García-Bragado F, García-Brotons P, Gavín O, Gómez C, Gómez V, González J, González-Marcano D, Grau E, Grimón A, Guijarro R, Gutiérrez J, Hernández-Comes G, Hernández-Blasco L, Hermosa-Los Arcos M, Jara-Palomares L, Jaras M, Jiménez D, Joya M, Llamas P, Lecumberri R, Lobo J, López P, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Maestre A, Marchena P, Martín-Martos F, Monreal M, Nieto J, Nieto S, Núñez A, Núñez M, Odriozola M, Otero R, Pedrajas J, Pérez G, Pérez-Ductor C, Peris M, Porras J, Reig O, Riera-Mestre A, Riesco D, Rivas A, Rodríguez C, Rodríguez-Dávila M, Rosa V, Ruiz-Giménez N, Sahuquillo J, Sala-Sainz M, Sampériz A, Sánchez-Martínez R, Sánchez Simón-Talero R, Sanz O, Soler S, Suriñach J, Torres M, Trujillo-Santos J, Uresandi F, Valero B, Valle R, Vela J, Vicente M, Villalobos A, Vanassche T, Verhamme P, Wells P, Hirmerova J, Malý R, Tomko T, del Pozo G, Salgado E, Sánchez G, Bertoletti L, Bura-Riviere A, Mahé I, Merah A, Moustafa F, Papadakis M, Braester A, Brenner B, Tzoran I, Antonucci G, Barillari G, Bilora F, Bortoluzzi C, Cattabiani C, Ciammaichella M, Di Biase J, Di Micco P, Duce R, Ferrazzi P, Giorgi-Pierfranceschi M, Grandone E, Imbalzano E, Lodigiani C, Maida R, Mastroiacovo D, Pace F, Pesavento R, Pinelli M, Poggio R, Prandoni P, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Gibietis V, Skride A, Vitola B, Monteiro P, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Bounameaux H, Calanca L, Erdmann A, Mazzolai L. Outcome of Patients with Venous Thromboembolism and Factor V Leiden or Prothrombin 20210 Carrier Mutations During the Course of Anticoagulation. Am J Med 2017; 130:482.e1-482.e9. [PMID: 27986523 DOI: 10.1016/j.amjmed.2016.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals with factor V Leiden or prothrombin G20210A mutations are at a higher risk to develop venous thromboembolism. However, the influence of these polymorphisms on patient outcome during anticoagulant therapy has not been consistently explored. METHODS We used the Registro Informatizado de Enfermedad TromboEmbólica database to compare rates of venous thromboembolism recurrence and bleeding events occurring during the anticoagulation course in factor V Leiden carriers, prothrombin mutation carriers, and noncarriers. RESULTS Between March 2001 and December 2015, 10,139 patients underwent thrombophilia testing. Of these, 1384 were factor V Leiden carriers, 1115 were prothrombin mutation carriers, and 7640 were noncarriers. During the anticoagulation course, 160 patients developed recurrent deep vein thrombosis and 94 patients developed pulmonary embolism (16 died); 154 patients had major bleeding (10 died), and 291 patients had nonmajor bleeding. On multivariable analysis, factor V Leiden carriers had a similar rate of venous thromboembolism recurrence (adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.82-1.64), half the rate of major bleeding (adjusted HR, 0.50; 95% CI, 0.25-0.99) and a nonsignificantly lower rate of nonmajor bleeding (adjusted HR, 0.66; 95% CI, 0.43-1.01) than noncarriers. Prothrombin mutation carriers and noncarriers had a comparable rate of venous thromboembolism recurrence (adjusted HR, 1.00; 95% CI, 0.68-1.48), major bleeding (adjusted HR, 0.75; 95% CI, 0.42-1.34), and nonmajor bleeding events (adjusted HR, 1.10; 95% CI, 0.77-1.57). CONCLUSIONS During the anticoagulation course, factor V Leiden carriers had a similar risk for venous thromboembolism recurrence and half the risk for major bleeding compared with noncarriers. This finding may contribute to decision-making regarding anticoagulation duration in selected factor V Leiden carriers with venous thromboembolism.
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Affiliation(s)
- Inna Tzoran
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
| | - Manolis Papadakis
- Haematology and Hemostasis Unit, Hospital Papageorgiou, Saloniki, Greece
| | - Benjamin Brenner
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Spain
| | - Agustina Rivas
- Department of Pneumonology, Hospital Universitario Araba, Álava, Spain
| | - Philip S Wells
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ontario, Canada
| | - Olga Gavín
- Department of Haematology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Farès Moustafa
- Department of Emergency, Clermont-Ferrand University Hospital, France
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Barcelona, Spain
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Mahé I, Chidiac J, Bertoletti L, Font C, Trujillo-Santos J, Peris M, Pérez Ductor C, Nieto S, Grandone E, Monreal M, Arcelus J, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Casado I, Culla A, de Miguel J, del Toro J, Díaz-Peromingo J, Falgá C, Fernández-Capitán C, Font C, Font L, Gallego P, García-Bragado F, García-Brotons P, Gómez V, González J, Grau E, Grimón A, Guirado L, Gutiérrez J, Hernández G, Hernández-Blasco L, Isern V, Jara-Palomares L, Jaras M, Jiménez D, Lacruz B, Lecumberri R, Lobo J, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Madridano O, Marchena P, Martín-Antorán J, Martín-Martos F, Monreal M, Morales M, Nauffal D, Nieto J, Nieto S, Núñez M, Otalora S, Otero R, Pagán B, Pedrajas J, Pérez C, Pérez G, Peris M, Porras J, Ramírez L, Reig O, Riera A, Rivas A, Rodríguez-Dávila M, Rosa V, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Martínez C, Sampériz A, Sala C, Sanz O, Soler S, Sopeña B, Suarez I, Suriñach J, Tiberio G, Tolosa C, Trujillo-Santos J, Uresandi F, Valle R, Vela J, Villalta J, Malfante P, Verhamme P, Wells P, Hirmerova J, Malý R, Tomko T, Salgado E, Bertoletti L, Bura-Riviere A, Farge-Bancel D, Hij A, Mahé I, Merah A, Papadakis M, Braester A, Brenner B, Tzoran I, Apollonio A, Barillari G, Candeloro G, Ciammaichella M, Di Micco P, Ferrazzi P, Grandone E, Lessiani G, Lodigiani C, Mastroiacovo D, Pace F, Pinelli M, Prandoni P, Rota L, Tiraferri E, Tufano A, Visonà A, Belovs A, Skride A, Moreira M, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Alatri A, Bounameaux H, Calanca L, Mazzolai L, Serrano J, Decousus H, Reis A. The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site. Am J Med 2017; 130:337-347. [PMID: 27884650 DOI: 10.1016/j.amjmed.2016.10.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 09/21/2016] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND We hypothesized that the clinical course of venous thromboembolism in patients with active cancer may differ according to the specificities of primary tumor site. AIM AND METHODS We used data from RIETE (international registry of patients with venous thromboembolism) to compare the clinical venous thromboembolism-related outcomes during the course of anticoagulation in patients with one of the 4 more frequent cancers (breast, prostate, colorectal, or lung cancer). RESULTS As of September 2014, 3947 cancer patients were recruited, of whom 938 had breast, 629 prostate, 1189 colorectal, and 1191 lung cancer. Overall, 55% had metastatic disease (42%, 36%, 53%, and 72%, respectively). During the course of anticoagulant therapy (mean duration, 139 days), the rate of thromboembolic recurrences was similar to the rate of major bleeding in patients with breast (5.6 [95% confidence interval (CI), 3.8-8.1] vs 4.1 [95% CI, 2.7-5.9] events per 100 patient-years) or colorectal cancer (10 [95% CI, 7.6-13] vs 12 [95% CI, 9.4-15] per 100 patient-years). In contrast, in patients with prostate cancer, the rate of venous thromboembolic recurrences was half the rate of major bleeding (6.9 [95% CI, 4.4-10] vs 13 [95% CI, 9.2-17] events per 100 patient-years), whereas in those with lung cancer, the rate of thromboembolic recurrences was twofold higher than the rate of major bleeding (27 [95% CI, 22-23] vs 11 [95% CI, 8.6-15] per 100 patient-years). CONCLUSIONS Significant differences in the clinical profile of venous thromboembolic-related outcomes were observed according to the site of cancer. These findings suggest the development of cancer-specific anticoagulant strategies as an area for further research.
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Affiliation(s)
- Isabelle Mahé
- Department of Internal Medicine, Hôpital Louis Mourier, Investigation Network on Venous Thrombo-embolism (INNOVTE), Colombes (APHP), University Paris 7, EA REMES 7334 France.
| | - Jean Chidiac
- Department of Internal Medicine, Hôpital Louis Mourier, Investigation Network on Venous Thrombo-embolism (INNOVTE), Colombes (APHP), University Paris 7, EA REMES 7334 France
| | - Laurent Bertoletti
- Department of Vascular and Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, French Clinical Research Infrastructure Network (F-CRIN), INNOVTE
| | - Carme Font
- Department of Medical Oncology, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clinic de Barcelona, Spain
| | - Javier Trujillo-Santos
- Department of Internal Medicine, Complejo Hospitalario Universitario de Cartagena, Murcia, Spain
| | - Marisa Peris
- Department of Internal Medicine, Hospital Provincial Castellon; CEU Cardenal Herrero University, Spain
| | - Cristina Pérez Ductor
- Department of Emergency Medicine, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Santiago Nieto
- Department of Haematology, Hospital de la Vega Lorenzo Guirao, Murcia, Spain
| | - Elvira Grandone
- Atherosclerosis and Thrombosis Unit, Casa Sollievo Della Sofferenza, Foggia, Italy
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Católica de Murcia, Spain
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Newton DH, Monreal Bosch M, Amendola M, Wolfe L, Perez Ductor C, Lecumberri R, Levy MM, Monreal M, Decousus H, Prandoni P, Brenner B, Barba R, Di Micco P, Bertoletti L, Tzoran I, Reis A, Bosevski M, Bounameaux H, Malý R, Wells P, Papadakis M, Agüero R, Aibar M, Alfonso M, Aranda R, Arcelus J, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Binetti J, Blanco-Molina A, Bueso T, Cañas I, Carmona F, Chic N, Culla A, del Pozo R, del Toro J, Díaz-Pedroche M, Díaz-Peromingo J, Falgá C, Fernández-Aracil C, Fernández-Capitán C, Fidalgo M, Font C, Font L, Gallego P, García M, García-Bragado F, Gómez V, González J, Grau E, Grimón A, Guirado L, Gutiérrez J, Hernández-Comes G, Hernández-Blasco L, Jara-Palomares L, Jaras M, Jiménez D, Joya M, Lecumberri R, Lobo J, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Manrique-Abos I, Marchena P, Martín M, Martín-Antorán J, Martín-Martos F, Monreal M, Nieto J, Nieto S, Núñez A, Núñez M, Otalora S, Otero R, Pagán B, Pedrajas J, Pérez G, Pérez I, Pérez-Ductor C, Peris M, Porras J, Reig O, Riera-Mestre A, Riesco D, Rivas A, Rodríguez-Dávila M, Rosa V, Rosillo-Hernández E, Ruiz-Artacho P, Ruiz-Giménez N, Sahuquillo J, Sala-Sainz M, Sampériz A, Sánchez R, Sanz O, Soler S, Sopeña B, Suriñach J, Tolosa C, Trujillo-Santos J, Uresandi F, Valero B, Valle R, Vela J, Vidal G, Villalta J, Vanassche T, Verhamme P, Wells P, Hirmerova J, Malý R, Salgado E, Bertoletti L, Bura-Riviere A, Champion K, Farge-Bancel D, Hij A, Mahé I, Merah A, Papadakis M, Braester A, Brenner B, Tzoran I, Antonucci G, Barillari G, Bilora F, Ciammaichella M, Dentali F, Di Micco P, Duce R, Ferrazzi P, Grandone E, Lodigiani C, Maida R, Pace F, Pesavento R, Poggio R, Prandoni P, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Drucka E, Kigitovica D, Skride A, Ramos A, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Bounameaux H, Erdmann A, Mazzolai L, Ney B. Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry. J Vasc Surg Venous Lymphat Disord 2017; 5:18-24.e1. [DOI: 10.1016/j.jvsv.2016.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/12/2016] [Indexed: 11/25/2022]
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Arraras JI, Illarramendi JJ, de la Cruz S, Asin G, Manterola A, Ibanez B, Salgado E, Cambra K, Zarandona U, Dominguez MA, Vera R. Erratum:Quality of life in long-term premenopausal early-stage breast cancer survivors from Spain. Effects of surgery and time since surgery. J BUON 2016; 21:1573. [PMID: 28039732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this article published in Volume 21, issue 5, the authors' names were incorrectly stated in the Pubmed abstract as: "Ignacio Arraras J(1), Juan Illarramendi J, de la Cruz S, Asin G, Manterola A, Ibanez B, Salgado E, Cambra K, Zarandona U, Angel Dominguez M, Vera R.". The correct authors' names are: "Arraras JI(1), Illarramendi JJ, de la Cruz S, Asin G, Manterola A, Ibanez B, Salgado E, Cambra K, Zarandona U, Dominguez MA, Vera R.". This error appeared only in the PubMed database and not in the print form of the Journal.
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Affiliation(s)
- J I Arraras
- Complejo Hospitalario de Navarra, Department of Medical Oncology, Pamplona, Spain
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Kurako K, Kurako V, Lowe J, Salgado E. PO03QUALITY OF LIFE IN ADULTS WITH GLIOMAS: LITERATURE REVIEW. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov284.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Giorgi-Pierfranceschi M, Di Micco P, Cattabiani C, Guida A, Pagán B, Morales MDV, Salgado E, Suriñach JM, Tolosa C, Monreal M. Platelet Count and Major Bleeding in Patients Receiving Vitamin K Antagonists for Acute Venous Thromboembolism, Findings From Real World Clinical Practice. Medicine (Baltimore) 2015; 94:e1915. [PMID: 26632687 PMCID: PMC5058956 DOI: 10.1097/md.0000000000001915] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The outcome of patients with acute venous thromboembolism (VTE) and abnormal platelet count (PlC) at baseline has not been consistently studied. In real-world clinical practice, a number of patients with abnormal PlC receive vitamin K antagonists (VKAs) to treat acute VTE despite their higher risk of bleeding.We used the Registro Informatizado de Enfermedad TromboEmbólica registry database to compare the rate of major bleeding in patients receiving VKA for long-term therapy of acute VTE according to PlC levels at baseline. Patients were categorized as having very low (<100,000/μL), low (100,000-150,000/μL), normal (150,000-300,000/μL), high (300,000-450,000/μL), or very high (>450,000/μL) PlC at baseline.Of 55,369 patients recruited as of January 2015, 37,000 (67%) received long-term therapy with VKA. Of these, 611 patients (1.6%) had very low PlC, 4006 (10.8%) had low PlC, 25,598 (69%) had normal PlC, 5801 (15.6%) had high PlC, and 984 (2.6%) had very high PlC at baseline. During the course of VKA therapy (mean, 192 days), there were no differences in the duration or intensity (as measured by international normalized ratio levels) of treatment between subgroups. The rate of major bleeding was 3.6%, 2.1%, 1.9%, 2.1%, and 3.7%, respectively, and the rate of fatal bleeding was 0.98%, 0.17%, 0.29%, 0.34%, and 0.50%, respectively. Patients with very low or very high PlC levels were more likely to have severe comorbidities.We found a nonlinear "U-shaped" relationship between PlC at baseline and major bleeding during therapy with VKA for VTE. Consistent alteration of PlC values at baseline suggested a greater frailty.
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Affiliation(s)
- Matteo Giorgi-Pierfranceschi
- From the Emergency Department, Val d'Arda Hospital, Piacenza, (MGP, CC); Department of Internal Medicine, Ospedale Buonconsiglio Fatebenefratelli, Naples, (PDM); University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno (AG); Department of Internal Medicine, Hospital de Madrid Norte Sanchinarro (BP); Department of Internal Medicine, Hospital del Tajo, Madrid, Spain (MDVM); Intensive Care Unit, Hospital Clinica La Merced, Quito, Ecuador (ES); Department of Internal Medicine, Hospital Vall d[Combining Acute Accent]Hebrón (JMS); Department of Internal Medicine, Corporación Sanitaria Parc Tauli, (CT); and Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain (MM)
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Kurako K, Lowe J, Kurako V, Salgado E. ED-14 * QUALITY OF LIFE IN ADULTS WITH GLIOMAS: LITERATURE REVIEW. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou253.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kurako K, Kurako V, Salgado E. ED-13 * POSTTRAUMATIC GLIOMA: LITERATURE REVIEW. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou253.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Maneiro J, Salgado E, Carmona L, Gomez-Reino J. FRI0079 Rheumatoid factor as predictor of response to non TNF antagonist biologic therapies in rheumatoid arthritis: Systematic review and meta-analysis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.2536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Salgado E, Maneiro J, Carmona L, Gomez-Reino J. AB0279 Rheumatoid factor and response to TNF antagonists in rheumatoid arthritis: Systematic review and meta-analysis of observational studies. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Salgado E, Maneiro J, Carmona L, Gomez-Reino J. THU0097 Systematic review of the safety of protein kinase inhibitors in clinical trials in rheumatoid arthritis:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.2062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Salgado E, Campos J, Moreira-Navarrete V, Mulero J, Navarro F, Perez-Pampin E, Carmona L, Gomez-Reino J. AB0278 The effect of rheumatoid factor titer on the response to TNF antagonists:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Santisteban M, López Díaz de Cerio A, García Cenoz M, Martín P, Zubiri L, Sola I, Espinós J, Salgado E, Fernández Hidalgo O, Inogés S. Abstract P4-13-04: Autologous dendritic cells vaccines combined with neoadjuvant chemotherapy increase total pCR in stages II-III non-overexpressing HER2 breast cancer patients and induce phenotypic changes in peripheral blood. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-13-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Based on the synergistic effect between immuno- and chemotherapy (CT), we have elaborated an autologous vaccine with dendritic cells loaded with patients´ own tumor antigens (lysate), and we have already demonstrated that the addition of the vaccines to a standard neoadjuvant CT schedule has increased total pCR (breast+ axilla) in stages II-III non-overexpressing HER2 breast cancer patients (Santisteban M, SABCS 2012). Both cohorts, the control (C) and the vaccinated (V) were well balanced related to demographic characteristics. Toxicity has been similar in both the C and the V cohorts. Moreover, we have analyzed the phenotypic changes in peripheral blood induced by the vaccine and its correlation with pathologic responses. Indeed, we have studied if the amount of lysate used to load the dendritic cells or the total dendritic cell numbers received by the patients in the first five doses (before surgery) is correlated with pCR Methods Twenty-eight patients with stage II-III HER2 negative breast cancer have started on sequential neoadjuvant CT based on dose dense antracyclines (E 100mg/m2 and C 600 mgr/m2) x4 cycles plus GM-CSF followed by taxanes (DOC 75-100 mgr/m2) x4 cycles plus vaccination. The C historic cohort was composed of thirty patients who received the same treatment except for the absence of the vaccines. Vaccine calendar was started after the 4th EC and alternated with DOC and as maintenance up to a maximum of a 2 year-period. The first 5 vaccines were administered before breast surgery. Changes in different lymphocytes populations were measured in peripheral blood of patients at different points by flow cytometry (absolute cell counts). To date, twenty-one patients have both determinations of lymphocyte subpopulations before the 1st and the 6th vaccine. Paired samples t-tests and Fisher exact were used Results pCR was superior in the V cohort (24% versus 3.3%, p = 0.04). Lymphocyte subpopulations were measured in peripheral blood (cells/uL) and a stimulation of the immune system was found after the 5 vaccines schedule at the time of surgery as follows: NK (p<0.001), T cytotoxic CD8 (p = 0.018), T helper CD4 (p = 0.04), CD19 (p = 0.001), HLADRCD8 (p = 0.007), CD16CD8 (p = 0.003), HLADRCD4 (p<0.001), CD16CD4 (p = 0.008) and T regulators lymphocytes (p = 0.004). We did not find any differences among CD57CD8 (p = 0.17), CD56CD8 (p = 0.11), CD57CD4 (p = 0.45) and CD56CD4 (p = 0.65). We neither see correlation among the amount of lysate to load dendritic cells and the tpCR (p = 0.09) nor the amount of dendritic cells (summatory of 5 vaccines) administered intradermally and the pCR (p = 0.59) Conclusions Immunotherapy added to standard neoadjuvant CT could improve total pCR in stage II-III non-overexpressing HER2 breast cancer patients. After 5 doses of vaccination plus chemotherapy, we can observe phenotypic changes in peripheral blood: some immune system subpopulations increased statistically after the treatment in vaccinated patients. Neither the amount of lysate nor the number of dendritic cells used in the five first vaccines significantly correlated with the pRC.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-13-04.
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Affiliation(s)
- M Santisteban
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - A López Díaz de Cerio
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - M García Cenoz
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - P Martín
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - L Zubiri
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - I Sola
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - J Espinós
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - E Salgado
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - O Fernández Hidalgo
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - S Inogés
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain; Preventive Medicine and Public Health, Pamplona, Navarra, Spain; Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
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Illarramendi JJ, Laplaza Y, Guarch R, Salgado E, Muruzabal JC, Garcia Bragado F, Aguirre S, De La Cruz S, Lainez N, Vera R. Abstract P1-13-10: Long-term pathologic findings in the female genital tract after completion of tamoxifen therapy for premenopausal breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-13-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Tamoxifen (TMX) remains the main compound for adjuvant hormone therapy in premenopausal breast cancer patients. Potential uterine carcinogenicity and other effects on the female genital tract are recognized risks for TMX, but further studies with longer follow-up are needed for the subpopulation of young premenopausal patients, with prolonged life span.
Material and Methods: Retrospective analysis of the female genital tract pathologic findings found in a population of premenopausal breast cancer patients who completed at least five years of adjuvant TMX (20 mg/d) in a single center with a minimum follow-up of 10 years since the start of TMX (1985-June 2003). Periodic gynecologic exams were offered to all the patients and biopsies were performed at the discretion of the reference gynecologists. Pathologic reports from biopsies and surgical specimens were retrieved from the pathology databases of our health system. Menopausal status was defined at diagnosis according to National Comprehensive Cancer Network´s standard criteria. This retrospective study was approved by our local ethics committee.
Results: 386 patients (p.) fulfilled inclusion criteria and were searched for data analysis. Median age at the start of TMX: 45 years (23-57). Median follow-up: 14.1 years (10.0-27.5). Further adjuvant hormone therapies were used in 94/386 p. (79 sequential aromatase inhibitors, 15 luteinizing hormone-releasing analogues).11 p. received further adjuvant TMX, mainly within the ATLAS trial, up to 10 years. Hysterectomies during the period of TMX therapy were performed in 24/386 p. Events in the population (all completed the programmed TMX adjuvant therapy) were as follows: 17 locoregional relapses, 37 systemic relapses, 18 contralateral breast cancer, 24 second neoplasms (3 pancreas, 1 endocrine pancreas, 4 melanoma, 4 colon, 3 sarcoma, 2 uterine, 1 ovary, 1 kidney, 1 tongue, 1 thyroid, 1 bladder, 1 lymphoma, 1 leukemia, 1 thyroid). Pathologic findings in the female genital tract after the end of tamoxifen were reported as follows: endometrial and cervical polyps (56), endometrial atrophy (16), endometrial hyperplasia (9), uterine leiomyoma (9), superficial and/or insufficient uterine samples (30), ovarian cysts (9), endometriosis (3), endometritis (1), chronic cervicitis (3), metaplasia (10), adenomyosis (3) vaginal leiomyoma (1), vulvar folliculitis (1), vaginal infiltration from metastatic breast cancer (1), ovarian fibroma (1), ovarian teratoma (1), ovarian metastases from breast cancer (1), vaginal papilloma (1), vaginal polyp (2), vulvar cyst (2),. Endometrial cancer was found in 2/386 p. One of these two patients had a deleterious BRCA2 mutation. Conclusions: The burden of pathologic complications in the female genital tract and endometrial cancer is regarded as low in initially premenopausal breast cancer patients who completed standard adjuvant tamoxifen, even after long follow-up.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-13-10.
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Affiliation(s)
| | - Y Laplaza
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - R Guarch
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Salgado
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - JC Muruzabal
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - S Aguirre
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - S De La Cruz
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - N Lainez
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - R Vera
- Complejo Hospitalario de Navarra, Pamplona, Spain
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Soriano Caminero A, Govindarajan R, Salgado E. Is HbA1c Level a Marker for Severity of Diabetic Distal Symmetric Polyneuropathy? (P03.198). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Morren J, Govindarajan R, Soriano Caminero A, Jones D, Rodriguez A, Salgado E. Quadruple Extracranial Arterial Dissection with Reversible Cerebral Vasoconstriction Syndrome (RCVS) in a Habitual Cocaine User Presenting with Thunderclap Headache (P03.216). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Govindarajan R, Morren J, Malpe C, Salgado E. Recurrent Herpes Simplex Type-2 Meningoencephalitis as a Stroke Mimicker (P02.265). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Morren J, Salgado E. Stroke Literacy, Stroke Behavior and Stroke Proficiency in a South Florida Population (P01.007). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Arrarás JI, Arias de la Vega F, Illarramendi JJ, Manterola A, Salgado E, Dominguez MA, Vera R. [Health-related quality of life in the oncology departments of the hospital of Navarra. The EORTC Quality of Life Group]. An Sist Sanit Navar 2011; 34:9-20. [PMID: 21532642 DOI: 10.4321/s1137-66272011000100002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Quality of life assessment is one of the key elements of the care that is offered to cancer patients. The aim of this work is to present the research line on quality of life that has been carried out since 1992 in the Oncology Departments of the Hospital de Navarra. These departments actively collaborate with the European Organisation of Research and Treatment of Cancer - EORTC - Quality of Life Group in creating questionnaires and also in other projects of this group. Our institution has coordinated the development process of the EORTC information module. Different EORTC questionnaires have been validated for use in our country. Quality of life studies have been carried out in the main tumour sites and in other areas, such as patients' satisfaction with care. This research line has a direct benefit on the attention that patients receive.
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Affiliation(s)
- J I Arrarás
- Red de salud mental, Servicio Navarro de Salud, Pamplona, Spain.
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Aboutanos MB, Mora F, Rodas E, Salamea J, Parra MO, Salgado E, Mock C, Ivatury R. Ratification of IATSIC/WHO’s Guidelines for Essential Trauma Care Assessment in the South American Region. World J Surg 2010; 34:2735-44. [DOI: 10.1007/s00268-010-0716-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Illarramendi Mañas JJ, Salgado E, Lainez N, Arrazubi V, Teijeira L, Vera R. [Orbital metastases of breast cancer]. An Sist Sanit Navar 2008; 31 Suppl 3:135-145. [PMID: 19169301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Orbital metastases are a defined subgroup within ocular affection secondary to the distant spread of breast cancer. We review the published experience on the incidence of orbit extension from this type of tumour, with reference made to our experience as medical oncologists, together with the most common clinical features and the relevant aspects for imaging and histopathological diagnoses. The therapy for orbital metastases from breast cancer is included within the systemic therapy required by the distant spread of the disease, with some clinical benefits obtained from hormone therapy, chemotherapy and monoclonal antibodies. Palliative radiation and surgery may also play an important role in providing care to these patients. Although there are some published cases with long-term survival, the prognosis for these patients is poor, and new advances in knowledge and therapy are needed for this complication due to breast cancer.
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Illarramendi J, Salgado E, Lainez N, Arrazubi V, Teijeira L, Vera R. Metástasis orbitarias del cáncer de mama. An Sist Sanit Navar 2008. [DOI: 10.4321/s1137-66272008000600012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Arraras JI, Arias F, Manterola A, Dominguez MA, Villafranca E, Martinez E, Illarramendi JJ, Salgado E, Vera R. Impact of radiotherapy on quality of life in elder women with localized breast cancer. A prospective study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19656 Background: the aims of the present study was to evaluate the impact of the radiotherapy in the Quality of Life (QL) in a sample of breast cancer elder patients with localized stages. Methods: The sample size was previously calculated using the program GRANMO 5.2 (Power O.8, a=0.01). During 2005, forty eight patients aged 65 years and older, stages I to III who started radiotherapy with or without hormonetherapy, have filled in the EORTC QLQ-C30 and QLQ-BR23 Quality of Life questionnaires three times: prior, end, and six weeks after the radiotherapy. Demographic data, performance status (Karnfosky scale), Daily Living Activities (DLA) with the IDDD scale, toxicity (CTC v2.0), co-morbidity and other clinical data have also been recorded Statistical analysis: Quality of Life and DLA scores, changes in them among the three assessments (Friedman, with Wilcoxon and Bonferroni criteria) have been calculated. Results: Quality of Life and DLA scores have been high in most dimensions in the three measurements. Moderate limitations (>30 points) have appeared in global Quality of Life, future worries, sexuality scales in the three measurements, and insomnia in the second. There are no significant differences in QL scores between the first and third measurements. In the second measurement there are moderate worsening (between 10 and 20 points) in fatigue, pain and breast symptoms and little (<10) in role, that have recovered in the third measurement. There has also been improvements between the second and third measurement in arm symptoms and global QL. No changes in DLA among the three measurements. Conclusions: Quality of Life in the elder patients has been good and the treatment adequately tolerated. Limited changes have appeared in treatment related areas that have recovered after a short follow-up period. Age should not be the only factor to consider when deciding the treatment protocol to administer. It would be desirable to confirm our results with a bigger sample. No significant financial relationships to disclose.
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Affiliation(s)
| | - F. Arias
- Hospital of Navarre, Pamplona, Spain
| | | | | | | | | | | | | | - R. Vera
- Hospital of Navarre, Pamplona, Spain
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Showler AT, Robacker D, Salgado E. Grandlure dosage and attraction of boll weevils (Coleoptera: Curculionidae). J Econ Entomol 2006; 99:1675-81. [PMID: 17066798 DOI: 10.1603/0022-0493-99.5.1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The effects of grandlure dosage on of boll weevil, Anthonomus grandis grandis Boheman (Coleoptera: Curculionidae), attraction were assessed. Traps collected more boll weevils under field and laboratory conditions as the amount of grandlure in laminated plastic strips was increased from 0 to 10, 30, and 60 mg. Spreading the point source of the lure by cutting the strip into quarters and positioning each quarter on separate corners of the large capacity trap to create an expanded source for the pheromone plume, however, resulted in fewer trap captures than traps with quartered lures all positioned on a single corner. The large capacity trap with the quartered lure on one corner also caught more weevils than the traps with an intact lure fastened to one corner. Although aging lure strips for three weeks reduced emissions of the four pheromone components and their attractiveness to boll weevils, cutting the aged lure into quarters resulted in greater emissions and attraction than lures that were aged intact or as quarters. Some pheromone components volatilized faster than others, resulting in time-related changes in blend ratios, but the underlying factor in boll weevil attraction to grandlure strips was dosage, the amount of volatilized pheromone available for interacting with an adult boll weevil.
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Affiliation(s)
- A T Showler
- USDA-ARS-APMRU, Kika de la Garza Subtropical Research Center, Weslaco, TX 78596, USA.
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Gomez-Puerta JA, Salgado E, Cervera R, Aguilo S, Ramos-Casals M, Soler M, Torras A, Font J. Catastrophic antiphospholipid syndrome presenting with renal thrombotic microangiopathy and diffuse proliferative glomerulonephritis. Clin Exp Rheumatol 2006; 24:110. [PMID: 16539830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
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Showler AT, Salgado E, Fraser I, Robacker DC. Effect of aging on pheromone emission from a commercial beet armyworm (Lepidoptera: Noctuidae) lure and trap efficiency. J Econ Entomol 2005; 98:373-7. [PMID: 15889726 DOI: 10.1603/0022-0493-98.2.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The effect of aging on a commercial pheromone-based lure for attractiveness to male adult beet armyworms, Spodoptera exigua (Hübner), was assessed in terms of trapping efficiency and volatile emissions of two key components: (Z,E)-9,12-tetradecadienyl acetate and (Z)-9-tetradecen-1-ol. In field assays conducted in the Lower Rio Grande Valley, Texas, for 9 wk (June-August 2000) and for 8 wk (March-May) in Tamaulipas, Mexico, 0-1-wk-old lures collected greater than four-fold more male beet armyworm adults than lures that had been aged for 3-4 wk. Using solid phase microextraction and gas chromatographic analysis of the volatiles, mean (Z,E)-9,12-tetradecadienyl acetate emission declined by 32% after 5 wk of aging in a ventilated environmental chamber at 29.4 degrees C, 3.5% RH, to simulate subtropical summers. Mean (Z)-9-tetradecen-1-ol emission was reduced by 62% after 4 wk of aging. Under the tropical and subtropical conditions of this study, the capacity of the lure to attract moths into the trap declined after aging for 3 wk. The blend ratio (Z,E) -9,12-tetradecadienyl acetate: (Z)-9-tetradecen-1-ol declined 29% when the lure was aged for 5 wk. This study will assist in the development of a standard trapping system for assessing adult beet armyworm populations in the tropical and subtropical conditions to which the species is endemic.
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Rodriguez J, Viudez A, Salgado E, García-Foncillas J, De La Cámara J, Espinós J, Garrán C, Chopitea A, Fernández-Hidalgo O, Martín-Algarra S. Irinotecan and mitomycin C (MMC) as salvage therapy for patients with metastatic colorectal cancer previously treated with fluoropyrimidine, irinotecan and/or oxaliplatin based chemotherapy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. Rodriguez
- Clínica Universitaria. University of Navarra, Pamplona, Spain
| | - A. Viudez
- Clínica Universitaria. University of Navarra, Pamplona, Spain
| | - E. Salgado
- Clínica Universitaria. University of Navarra, Pamplona, Spain
| | | | - J. De La Cámara
- Clínica Universitaria. University of Navarra, Pamplona, Spain
| | - J. Espinós
- Clínica Universitaria. University of Navarra, Pamplona, Spain
| | - C. Garrán
- Clínica Universitaria. University of Navarra, Pamplona, Spain
| | - A. Chopitea
- Clínica Universitaria. University of Navarra, Pamplona, Spain
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Viúdez A, Rodríguez J, De La Cámara J, Salgado E, Chopitea A, Gil-Bazo I, García-Foncillas J, Valero J, Espinós J, Martin-Algarra S. Triplet therapy with gemcitabine, 5-fluorouracil, leucovorin and cisplatin in patients with metastatic pancreatic cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Viúdez
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - J. Rodríguez
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - J. De La Cámara
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - E. Salgado
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - A. Chopitea
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - I. Gil-Bazo
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - J. García-Foncillas
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - J. Valero
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - J. Espinós
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
| | - S. Martin-Algarra
- Clínica Universitaria. University of Navarra, Pamplona, Spain; Clinica Universitaria, Pamplona, Spain
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Santisteban M, Viudez A, Salgado E, Garrán C, Navarro V, De La Cámara J, Fernández-Hidalgo O, García-Velloso MJ, Martín-Algarra S. Role of 18F-fluorodeoxyglucose positron emission tomography in mucocutaneous malignant melanoma. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - A. Viudez
- Clínica Universitaria, Pamplona, Spain
| | | | - C. Garrán
- Clínica Universitaria, Pamplona, Spain
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